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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION

NEW DELHI

REVISION PETITION NO. 1386 OF 2022

(Against the Order dated 01/08/2022 in Appeal No. 1030/2019 of the State Commission Uttar
Pradesh)
1. IFFCO TOKIO GENERAL INSURANCE COMPANY LTD.
CHAMBER 20 A R.K. GARG BLOCK SUPREME COURT OF
INDIA
GURUGRAM
HARYANA ...........Petitioner(s)
Versus
1. SHISHIR BHATNAGAR
C-114, JALVAYU TOWERS, PLOT NO. A-38A, SEC. 47,
NOIDA, DISTRICT GAUTHAM BUDH NAGAR
GAUTAM BUDDHA NAGAR
UTTAR PRADESH
2. PARAMOUNT HEALTH SERVICES PVT. LTD.,
THORUGH ITS MANAGING DIRECTOR, TPA OF IFFCO
TOKIO GENEREAL INSURANCE COMPANY, REGISTERED
OFFICE :- D - 39, OKHLA INDUSTRIAL ESTATE,
NEW DELHI ...........Respondent(s)

BEFORE:
HON'BLE AVM J. RAJENDRA, AVSM VSM (Retd.),PRESIDING MEMBER

FOR THE PETITIONER : FOR PETITIONER : MR. SUYASH VYAS, PROXY COUNSEL
WITH
AUTHORITY LETTER OF MR.GOPAL SINGH, ADV.
FOR THE RESPONDENT : FOR RESPONDENT NO.1 : MR.ABHISHEK SINGH, ADVOCATE &
MR. KARAN CHAUDHARY, ADV. WITH
FATHER OF RESPONDENT NO.1.
FOR RESPONDENT NO.2 : NOT APPEARED

Dated : 09 February 2024

ORDER
1. This Revision Petition No. 1386 of 2022 challenges the impugned order of Uttar Pradesh
State Consumer Disputes Redressal Commission, Lucknow (‘the State Commission’) dated
01.08.2022. Vide this order, the State Commission dismissed First Appeal No. A/1030/2019 and
affirmed the order of the District Consumer Disputes Redressal Forum, Gautam Budha Nagar,
U.P. (‘the District Forum’) dated 25.07.2019.

2. Brief facts of the case, as per the Complainant, are that he had taken Individual Medishield
Insurance Policy of Rs.10,00,000/- vide Policy No. 52172871 valid from 05.11.2010 to
04.11.2011 by paying premium of Rs.13,820.93. During the subsistence of the policy, he had
met with an accident, hospitalised and incurred Rs.9,87,639/- as expenses. However, the OP-1
repudiated the Complainant’s claim on the ground of influence of alcohol. Being aggrieved, the
Complainant filed a Consumer Complaint before the District Forum.

3. In reply, OP-1 admitted insurance policy valid from 05.11.2010 to 04.11.2011 with terms
and condition as stipulated and agreed between the parties. The claim of the Complainant was
repudiated rightly as per point no.8 of the policy terms and conditions “What is not covered”
which states as under:-

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“Convalescence, general debility, run down condition or rest cure, congenital disease or
defects or anomalies, sterility, venereal disease, intentional self-injury and use of
intoxicating drugs/ alcohols.” Thus, the complaint be dismissed.

4. The learned District Forum vide order dated 25.07.2019, allowed the complaint and
directed the Opposite Party as under:

“The complaint cost is accepted by the complainant against the opposite parties. The
opposition insurance company is ordered to pay a total marking of Rs 9,87,639/- as
desired by the complainant. Pay (Rs.9 lakh, 87 thousand, six hundred and forty- nine
rupees only) at the rate of 8% per annum simple interest to the complainant from the
date of rejection of the insurance claim to the date of actual payment within 30 days of
this order. The complainant will also be entitled to receive Rs.50,000/- and Rs.10,000/-
respectively for mental pain and physical pain and litigation expenses from the
opposition insurance company, which the opposition insurance company will pay to the
complainant during the said period. Accordingly, copies of the judgment should be
issued to the parties as per rules and the files should be stored in the archives.”

(Extracted from translated copy)

5. Being aggrieved by the impugned order, the Petitioner filed an Appeal before the State
Commission. The learned State Commission, vide order dated 01.08.2022 observed as follows:

“Heard the learned counsel for both the sides and perused the decision/order and
file in question

The main contention of learned counsel for the appellant is that when the
insured person was admitted to the hospital after the injury, a note was made that the
injured person was in an alcoholic state. No affidavit from the concerned hospital doctor
has been submitted to prove this report, yet also that no medical test has been done to
prove the presence of alcohol, so this report cannot be considered reliable. Again, on the
basis of this report, it is not even sure how much alcohol was to be taken. This report
does not provide evidence that the insured has lost control of his/her discretion due to
consumption of alcohol, So there is no power in this argument. Therefore, there is no
ground to interfere with the decision/order passed by the District Consumer
Commission. Appeal is liable to be dismissed.

Order

The appeal is dismissed. The decision/order in question dated 25/7/2019 passed in

the complaint number-196/2014 by the District Consumer Commission, Gautan Budh
Nagar is confirmed.

In appeal, the parties will bear their own litigation expenses.

Under Section-15 Consumer Protection Act, 1986, the amount deposited in the
appeal along with interest earned of Rs.25,000.00 should be sent to the concerned
District Consumer Commission for disposal.”
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(Extracted from translated copy)

6. In his arguments, the learned Counsel for the Petitioners reiterated the grounds in the
Revision Petition and asserted that the Complainant was under the influence of alcohol at the
time of accident and, therefore, the repudiation of claim was justified as per terms of the
insurance policy. He sought the impugned orders of the lower fora be set aside. He has relied
upon the following judgments:

(a) IFFCO Tokio General Insurance Co. Ltd. Vs. Pearl Beverages Ltd., (2021) 7 SCC
704;

7. The learned Counsel for the Respondent/Complainant argued in support of the impugned
orders passed by the learned District Forum and the State Commission.

8. I have examined the pleadings and associated documents placed on record, including the
reasoned orders of the learned District Forum and the learned State Commission and rendered
thoughtful consideration to the arguments advanced by the learned Counsels for both the parties.

9. The learned District Forum issued a well-reasoned order based on evidence and arguments
advanced before it. The learned State Commission, after due consideration of the pleadings and
arguments, determined that no intervention is warranted on the District Forum's order. This was
primarily because the grounds relied upon in the repudiation letter are not supported by leading
any cogent and convincing evidence with regard to the complainant was under the influence of
alcohol at the time of accident. This order is now under challenge at the revision stage.

10. It is a well settled position in law that the scope for Revision under Section 21(b) of the
Consumer Protection Act, 1986 and now under Section 58(1)(b) of the Consumer Protection
Act, 2019 confers very limited jurisdiction on this Commission. In the present case, there
are concurrent findings of the facts and the revisional jurisdiction of this Commission is limited.
After due consideration of the entire material, I do not find any illegality, material irregularity or
jurisdictional error in the impugned Order passed by the learned State Commission warranting
our interference in revisional jurisdiction under the Act. I place reliance on the decision of the
Hon’ble Supreme Court in the case of ‘Rubi (Chandra) Dutta Vs. M/s United India Insurance
Co. Ltd., (2011) 11 SCC 269.

11. In addition, Hon’ble Supreme Court in ‘Sunil Kumar Maity vs. SBI & Anr. Civil Appeal
No. 432 OF 2022 Order dated 21.01.2022 observed as follows:-

“9. It is needless to say that the revisional jurisdiction of the National Commission under
Section 21(b) of the said Act is extremely limited. It should be exercised only in case as
contemplated within the parameters specified in the said provision, namely when it
appears to the National Commission that the State Commission had exercised a
jurisdiction not vested in it by law, or had failed to exercise jurisdiction so vested, or had
acted in the exercise of its jurisdiction illegally or with material irregularity. In the instant
case, the National Commission itself had exceeded its revisional jurisdiction by calling for
the report from the respondent-bank and solely relying upon such report, had come to the

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conclusion that the two fora below had erred in not undertaking the requisite in-depth
appraisal of the case that was required. .....”

12. Similarly, in a recent order the Hon'ble Supreme Court in Rajiv Shukla Vs. Gold Rush
Sales and Services Ltd. (2022) 9 SCC 31 has held that:-

As per Section 21(b) the National Commission shall have jurisdiction to call for the
records and pass appropriate orders in any consumer dispute which is pending before or
has been decided by any State Commission where it appears to the National Commission
that such State Commission has exercised its jurisdiction not vested in it by law, or has
failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction
illegally or with material irregularity. Thus, the powers of the National Commission are
very limited. Only in a case where it is found that the State Commission has exercised its
jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested
illegally or with material irregularity, the National Commission would be justified in
exercising the revisional jurisdiction. In exercising of revisional jurisdiction the National
Commission has no jurisdiction to interfere with the concurrent findings recorded by the
District Forum and the State Commission which are on appreciation of evidence on record.

13. Based on the deliberations above, I do not find any merit in the present Revision Petition
and the same is, therefore, Dismissed and the order of the learned District Forum dated
25.07.2019 is modified to the extent that the compensation of Rs.50,000/- awarded on account
of mental agony and harassment awarded is set aside in view of the judgment of the Hon’ble
Supreme Court in the case of DLF Homes Panchkula Pvt. Ltd. Vs. D.S. Dhanda, in CA Nos.
4910-4941 of 2019 decided on 10.05.2019 has held that multiple compensations for singular
deficiency is not justifiable.

14. Keeping in view the facts and circumstances of the present case, there shall be no order as
to costs.

15. All pending Applications, if any, also stand disposed of accordingly.

...................................................................................
AVM J. RAJENDRA, AVSM VSM (Retd.)
PRESIDING MEMBER

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